American Epilepsy Society

View all recommendations from this society

August 15, 2018

Avoid routine testing for antiepileptic drug (AED) levels in people with epilepsy.

AED level testing should not be routinely ordered when seizures are well controlled, and no adverse effect is suspected. The reference ranges should not be used as a rigid framework. The effectiveness and tolerability of treatments should be determined by the clinical responses. AED levels should be ordered to address a specific question. Some examples include weight-based dosing adjustments in young children, adherence, suspected toxicity, and pregnant women.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American Epilepsy Society (AES) and the AES Practice Management Committee (PMC) worked together to prepare the five statements from 2016–2018. The PMC met in person in December 2016 to use the ABIM Foundation’s Operating Principles for Clinician Organizations’ Participation in the Choosing Wisely Campaign to discuss and propose topics for further development. The PMC ultimately proposed seven potential topics for further discussion and tasked a subgroup of seven committee members to draft seven Choosing Wisely statements. Once drafted, each item was voted upon by the PMC subgroup for further inclusion.

Voters were provided additional instructions to select the item for further inclusion if it had (1) clinical relevance, (2) clinical validity, and (3) clarity of concept. Voting occurred electronically. Two items were eliminated, and five items were selected for further and final development. The final five items were completed by individual PMC subgroup members. The entire PMC subgroup then reviewed each statement for final editing and final vote for submission to Choosing Wisely, based on the same criteria mentioned above. Items receiving at least six “yes” votes (among seven voters) were advanced and reformatted and edited by the Practice Committee Chair, Dr. Gabriel Martz, to adhere to the ABIM Foundation’s Choosing Wisely submission specifications. The PMC subgroup then re-evaluated items to ensure consistency of message after re-formatting, and again voted on each item individually for or against advancement for review and consideration of approval by the AES Council on Clinical Activities, AES Executive Committee, AES Board of Directors. The AES Board of Directors provided feedback and final approval of the five statements for submission to the ABIM Foundation for consideration of inclusion in the Choosing Wisely Campaign. The PMC will review the statements on an annual basis to ensure adherence to the Foundation’s Operating Principles and that the statements continue to be supported by generally accepted evidence and are applicable to current clinical practice.

Sources

Eadie MJ Therapeutic drug monitoring – antiepileptic drugs. Br J Clin Pharmacol 1998; 46:185-193.

Patsalos PN et al Antiepileptic drugs—best practice guidelines for therapeutic drug monitoring: A position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies. Epilepsia 2008, 49(7):1239–1276.

St. Louis EK Monitoring Antiepileptic Drugs: A Level-Headed Approach. Current Neuropharmacology, 2009, 7:115-119.

Affolter N et al Appropriateness of serum level determinations of antiepileptic drugs. Swiss Med Wkly 2003; 133:591-597.

Tomson T et al Therapeutic monitoring of antiepileptic drugs for epilepsy (Review). Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD002216. Copyright © 2010 The Cochrane Collaboration. John Wiley & Sons, Ltd.

Walters RJL et al Inappropriate requests for serum anti-epileptic drug levels in hospital practice. Q J Med 2004, 97:337-341.

Stepanova D, Beran RG. The benefits of antiepileptic drug (AED) blood level monitoring to complement clinical management of people with epilepsy. Epilepsy Behav. 2015; 42:7-9.